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191 Cards in this Set
- Front
- Back
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MV auscultation
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apex
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TV auscultation
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left parasternal border
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AV auscultation
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right 2nd intercostal space
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PV auscultation
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left 2nd intercostal space
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Sl
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closure MV and TV
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S2
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closure AV and PV
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Inspiration
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split in A2 and P2; due to increased blood in right side of heart
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S3
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abnormal; due to blood entering volume overloaded ventricle in early diastole
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Causes of S3
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valve regurgitation; congestive heart failure
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S4
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abnormal; due to blood entering non-compliant ventricle with atrial contraction in late diastole
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Causes of S4
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volume overloaded ventricle, hypertrophy
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Murmurs
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stretching valve ring or damage to valve
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Inspiration
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increases right sided abnormal heart sounds and murmurs
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Expiration
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increases left sided abnormal heart sounds and murmurs
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Stenosis murmurs
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problem in opening valve
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Regurgitation murmurs
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problem in closing valve
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Valves opening in systole
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AV and PV
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Valves opening in diastole
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MV and TV
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Valves closing in systole
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MV and TV
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Valves closing in diastole
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AV and PV
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LDL
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primary vehicle for carrying cholesterol
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VLDL
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primary vehicle for carrying liver-synthesized triglyceride
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Familial hypercholesterolemia (type II):
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AD; deficiency of LDL receptors; inc LDL
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Type III hyperlipoproteinemia
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deficiency apo E; T remnants (chylomicron, intermediate density)
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Type IV hyperlipoproteinemia
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inc VLDL; alcoholics
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Apo B deficiency
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deficiency apo B48 (chylomicrons) and B 100 (VLDL); L CH and TG
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Clinical findings in apo B deficiency
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malabsorption; hemolytic anemia
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Atherosclerosis
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reaction to injury of endothelial cells
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Risk factors of atherosclerosis
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smoking, T LDL, T homocysteine, Chlamydiapneumoniae infection
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Cells involved in atherosclerosis
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platelets, macrophages, smooth muscle cells, T cells with cytokine release
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Fibrous plaque
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pathognomonic lesion of atherosclerosis
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C-reactive protein
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marker of an inflammatory atheromatous plaque
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Inflammatory atheromatous plaque
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predisposes to platelet thrombosis
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Increased plasma homocysteine
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inc vessel thrombosis; folate (MC)/vitamin B12 deficiency
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Hyaline arteriolosclerosis
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small vessel disease of DM and hypertension; excess protein in vessel wall
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Mechanisms of hyaline arteriolosclerosis in DM
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non-enzymatic glycosylation
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Non-enzymatic glycosylation
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glucose attaches to amino acids in BM; causes inc permeability to protein
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Mechanisms hyaline arteriolosclerosis in hypertension
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pressure pushes proteins into vessel wall
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Abdominal aortic aneurysm rupture
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due to atherosclerosis; flank pain, hypotension, pulsatile mass
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Syphilitic aneurysm
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vasculitis of vasa vasorum of aortic arch; aortic regurgitation
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Aortic dissection
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due to hypertension and collagen tissue disorders (e.g., Marfan)
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Cystic medial degeneration
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elastic tissue degeneration creates spaces filled with mucopolysaccharides
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Intimal tear in aorta
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due to wall stress from hypertension and structural weakness
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Types of dissection
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proximal (MC); distal or combination of both
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S/S proximal aortic dissection
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chest pain radiating to back, lack of pulse; cardiac tamponade MC COD
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Marfan's
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AD; fibrillin defect; aortic regurgitation/dissection; lens dislocation; MVP with sudden death
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MC COD Marfan's and Ehlers Danlos
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aortic dissection
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Phlebothrombosis
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stasis of blood flow; deep veins below knee MC site
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Pulmonary thromboembolism
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emboli originate from femoral veins
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Superficial migratory thrombophlebitis
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sign of carcinoma of head of pancreas
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Thoracic outlet syndrome
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absent radial pulse with positional change
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Turner's syndrome
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lymphedema hands/feet in newborn; preductal coarctation
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Spider telangiectasia
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arteriovenous fistula; due to hyperestrinism (cirrhosis, pregnancy)
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Capillary hemangioma in newborn
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regress with age; do not surgically remove
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Kaposi's sarcoma
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HHN-8; vascular malignancy; MC cancer in AIDS
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Bacillary angiomatosis
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Bartonella henselae; vascular infection in AIDS
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Small vessel vasculitis
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palpable purpura; e.g., Henoch Schonlein purpura
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Muscular artery vasculitis
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vessel thrombosis with infarction; e.g., classical polyarteritis nodosa
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Elastic artery vasculitis
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absent pulse, stroke
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Takayasu's arteritis
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pulseless disease young Asian woman
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Giant cell arteritis
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temporal artery granulomatous vasculitis; ipsilateral blindness (ophthalmic artery)
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Classical polyarteritis nodosa
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muscular artery vasculitis with vessel thrombosis infarction
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Path findings of Classical polyarteritis nodosa
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vessel inflammation at different stages; aneurysms from vessel weakness
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S/S of Classical polyarteritis nodosa
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infarctions in kidneys, skin, GI tract, heart; HBsAg in 30%
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Diagnosis of polyarteritis nodosa
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angiography identifies aneurysms and thrombosis
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Kawasaki's disease
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coronary artery vasculitis/ thrombosis/ aneurysms in children
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S/S of Kawasaki's disease
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chest pain; desquamating rash; swelling hands/feet; cervical lymphadenopathy
Rx: IV gamma-globulin |
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Buerger's disease (thromboangiitis obliterans):
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smoker's digital vasculitis; digital infarction
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Raynaud's syndrome
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digital vasculitis in PSS and CREST syndrome
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S/S of Raynaud's Syndrome
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digital pain; white-blue-red color changes
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Cryoglobulinemia
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protein gels in cold temperature; Raynaud's syndrome; HCV association
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Cryoglobulinemia S/S
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acral cyanosis relieved by coming indoors
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Wegener's granulomatosis
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association with c-ANCA; sinusitis, lung infarction, crescentic GN
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Microscopic polyangiitis
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palpable purpura; crescentic GN; association with p-ANCA
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Henoch-Schonlein purpura
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IgA-anti-IgA ICs; palpable purpura buttocks/legs; arthritis; IgA GN
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Serum sickness vasculitis
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e.g., horse antivenin in Rx of rattlesnake envenomation
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Rocky Mtn spotted fever
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tick borne Rickettsia infection; vasculitis causes petechia on palms -> trunk
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Meningococcemia
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sepsis causes petechia/ecchymoses; potential for Waterhouse Friderichsen syndrome
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Essential HTN blacks
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defect in renal excretion of sodium; inc plasma volume, dec PRA
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Renovascular HTN
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atherosclerosis renal artery in men; fibromuscular hyperplasia renal artery women
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S/S of Renovascular HTN
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epigastric bruit; inc PRA affected kidney, dec PRA unaffected kidney
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Endocrine HTN
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primary HPTH, Graves/ hypothyroidism, Cushings, primary aldosteronism, pheochromocytoma
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Hypertension
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LVH MC complication; AMI MC COD followed by stroke and renal failure
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Afterload
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resistance ventricles contract against
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Preload
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volume ventricles must eject
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Concentric LVH
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increased afterload; e.g., essential HTN, aortic stenosis
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LVH with dilation/hypertrophy
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increased preload; e.g., valve regurgitation; left to right shunts
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LHF
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forward failure; pulmonary edema, pillow orthopnea, paroxysmal nocturnal dyspnea
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Systolic dysfunction
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LHF due to decreased ventricular contractility (ischemia)
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Diastolic dysfunction
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LHF due to decreased ventricular compliance (hypertrophy)
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RHF
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backward failure; T venous hydrostatic pressure; neck vein distention, hepatomegaly, edema
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ACE inhibitors
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decrease afterload and preload in heart failure
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Diuretics in CHF
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reduce preload
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Non-pharmacologic Rx in CHF
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restrict salt and water
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Ant. MI
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MC COD in United States; left anterior descending coronary artery thrombosis MCC
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Exertional angina
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coronary artery atherosclerosis; subendocardial ischemia; ST depression
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Prinzmetal's angina
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coronary artery vasospasm; transmural ischemia; ST elevation
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Sudden cardiac death
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death within 1 hr of symptoms
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Path findings in sudden cardiac death
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severe coronary artery atherosclerosis; absence of occlusive thrombosis
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LAD coronary artery
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anterior portion left ventricle, anterior 2/3rds IVS
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RCA (coronary artery)
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posterior portion left ventricle and papillary muscle, inferior 1/3rd IVS, right ventricle
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Acure MI
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rupture of inflammatory plaque produces platelet thrombus
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Ventricular fibrillation
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MC COD in Acute. MI
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Acute MI
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no gross changes until 24 hrs
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S/S of Acute MI
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retrosternal pain radiating down arms, diaphoresis
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Acute MI ruptures
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3rd-7th day
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Anterior wall rupture
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MC type; LAD thrombosis; cardiac tamponade
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Posteromedial papillary muscle rupture
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RCA thrombosis; mitral regurgitation with LHF
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IVS rupture
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LAD thrombosis; left to right shunt; RHF
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Mural thrombus
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anterior Acute MI; danger embolization
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Pericarditis
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first week in transmural Acute MI; 6 wks later autoimmune
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S/S of Pericarditis
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friction rub; leaning forward relieves pain
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Ventricular aneurysms
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late manifestation of Acute MI; precordial systolic bulge; CHF MC COD
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Right ventricular infarction
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RCA thrombosis; hypotension, RHF, preserved left ventricular function
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Diagnosis of Acute MI:
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CK-MB and troponins; CK-MB absent by 3 days; troponins last 7-10 days
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LDH isoenzymes
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no longer used; LDH 1/2 flip indicates Acute MI
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Reinfarction
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reappearance CK-MB after 3 days
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ECG findings in Acute MI
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inverted T waves; ST elevation; Q waves
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Ejection fraction
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EF = stroke volume/left ventricular end-diastolic volume; 80/120 = 0.66
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By-pass surgery
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use internal mammary artery and saphenous veins ("arterialize" after 10 yrs)
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Angioplasty complication
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localized dissection with thrombosis
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Umbilical vein
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highest O2 saturation
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Ductus arteriosis in fetus
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shunts blood from pulmonary artery to aorta; PGE keeps it open
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Ductus arteriosus in newborn
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closes and becomes ligamentum arteriosum
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Eisenmenger's syndrome
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cyanosis due to reversal of left to right shunt
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VSD
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MC congenital heart disease; inc Sa02 right ventricle (RV), pulmonary artery (PA)
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ASD
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patent foramen ovale; inc Sa02 right atrium (RA), RV, PA; MC adult congenital heart disease
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Down syndrome and heart disease
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endocardial cushion defect (combined ASD and VSD)
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PDA
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machinery murmur; close with indomethacin; inc Sa02 PA
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Tetralogy of Fallot
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degree of pulmonic stenosis determines if cyanosis is present
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Tetralogy of Fallot
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decreased SaO2 in left ventricle, aorta
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Tetralogy of Fallot
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ASD and PDA are cardioprotective
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Complete transposition
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cyanosis; aorta empties RV; PA empties left ventricle
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Complications cyanotic heart disease
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secondary polycythemia; infective endocarditis; metastatic abscesses
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Pre-ductal coarctation
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Turner's syndrome
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Post-ductal coarctation
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constriction distal to ligamentum arteriosum
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S/S of post-ductal coarctation
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upper extremity HTN; claudication; rib-notching; activation RAA also causes HTN
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Acute rheumatic fever
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type II hypersensitivity; group A streptococcus pharyngeal infection
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Acute rheumatic fever
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sterile vegetations mitral valve (regurgitation); myocarditis with Aschoff nodule
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S/S of Acute rheumatic fever
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polyarthritis (MC), carditis, erythema marginatum, rheumatoid nodules, chorea
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Mitral stenosis
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chronic rheumatic fever; opening snap followed by mid-diastolic rumble
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Mitral stenosis
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left atrial dilation/hypertrophy- atrial fibrillation, thrombus, pulmonary edema, RHF
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Mitral Valve Prolapse
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myxomatous degeneration of mitral valve; common in Marfan syndrome, Ehlers Danlos
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Mitral Valve Prolapse S/S
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mid-systolic click followed by a murmur; palpitations, chest pain, rupture of chordae
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Mitral Valve Prolapse click/murmur close to S1
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decrease preload (stand, Valsalva, anxiety)
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Mitral Valve Prolapse click/murmur close to S2
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increase preload (supine, squat, clench fist)
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Mitral regurgitation
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pansystolic murmur; S3 and S4 common
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Causes of mitral regurg
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LHF, infective endocarditis, acute rheumatic fever
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Aortic stenosis
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systolic ejection murmur; syncope and angina with exercise; hemolytic anemia
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Aortic stenosis murmur increased preload
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worsens obstruction and increases murmur intensity
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Aortic stenosis murmur with decreased afterload
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decreases obstruction and decreases murmur intensity
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Causes of aortic stenosis
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bicuspid aortic valve; age-related sclerosis
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Aortic regurgitation
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bounding pulses; early diastolic blowing murmur
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Austin Flint murmur
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diastolic murmur; regurgitant flow on anterior leaflet mitral valve
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Significance Austin Flint murmur
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sign for AV replacement
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Causes of aortic regurgitation
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essential HTN, infective endocarditis, acute rheumatic fever, dissection
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Tricuspid regurgitation
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pansystolic murmur increases intensity with inspiration
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Causes of tricuspid regurgitation
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endocarditis IV drug abuse; RHF; carcinoid heart disease
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Carcinoid heart disease
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tricuspid regurgitation, pulmonic stenosis
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Infective endocarditis (IE):
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Streptococcus viridans MCC; Staphylococcus aureus MCC IVDA IE prosthetic heart valve: Staphylococcus epidermidis (coagulase negative)
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IE ulcerative bowel disease
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Streptococcus bovis
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S/S of IE ulcerative bowel disease
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IC vasculitis- Roth spot, splinter hemorrhages; regurgitant murmurs; metastatic abscesses
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Lab findings of IE ulcerative bowel disease
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positive blood culture
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Libman Sacks endocarditis
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sterile vegetations mitral valve associated with SLE
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Coxsackievirus and heart disease
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MCC of myocarditis (lymphocyte infiltrate in myocardium) and pericarditis
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Parasitic cause of myocarditis
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leishmania in Chagas disease
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Pericardial effusion
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all chamber pressures are uniformally increased
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S/S of pericardial effusion
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muffled heart sounds, pulsus paradoxus, inspiratory neck vein distention
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Dx and Rx of pericardial effusion
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echocardiogram, pericardiocentesis, respectively
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Pulsus paradoxus
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drop in blood pressure > 10 mm Hg with inspiration
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Constrictive pericarditis
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TB MCC worldwide; pericardial knock
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Congestive cardiomyopathy
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generalized chamber enlargement; low ejection fraction
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Causes of congestive cardiomyopathy
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postpartum, cardiotoxic drugs, hypothyroidism, alcohol
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Hypertrophic cardiomyopathy
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MCC of sudden death in young person (due to conduction defects)
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Site of obstruction in hypertrophic cardiomyopathy
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anterior leaflet mitral valve drawn against asymmetric thickened IVS
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Effect decreased preload on systolic murmur
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worsens obstruction and increases murmur intensity
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Effect increased preload on systolic murmur
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reduces obstruction and decreases murmur intensity
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Restrictive cardiomyopathy
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decreased compliance
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Causes of restrictive cardiomyopathy
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iron, amyloid, glycogen; sarcoidosis; tropical endocardial fibrosis
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Cardiac myxoma
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benign tumor left atrium; embolization; syncope
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Cardiac rhabdomyoma
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childhood tumor; association with tuberous sclerosis
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U wave
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hypokalemia; MCC diuretic therapy (e.g., thiazides; loop diuretics)
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Peaked T wave
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hyperkalemia; MCC renal failure
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ST depression
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subendocardial ischemia (e.g., classical angina pectoris).
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ST elevation
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transmural ischemia (e.g., AMI), pericarditis, ventricular aneurysm
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Atrial fibrillation
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MC chronic arrhythmia; absent P waves; danger for embolization
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Ventricular premature beats
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wide QRS complexes; MC arrhythmia in coronary care unit
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Ventricular fibrillation
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MCC of death in an Acute MI
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Anterior Acute MI
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Q waves I VI-V4
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Inferior Acute MI
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Q waves in II, III, and aVF. Right coronary artery thrombosis
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Wolff-Parkinson-White
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short PR interval with normal P wave; delta wave on upstroke of R wave
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